State starts upgrade to system for Medicaid claims

DENVER – The Colorado Department of Health Care Policy and Financing will this year begin implementing a plan to update the system it uses to process Medicaid claims – a $117 million endeavor.

The current system, called the Medicaid Management Information System, includes components that are more than 30 years old, according to department spokesman Marc Williams. The new system will be in place by November 2016.

The old software is expensive to maintain because finding employees with the proper training for a system that old is difficult, Williams said. In addition, workarounds and manual processes have to be adopted in order to accommodate regulatory changes at the federal and state level.

The Medicaid Management Information System deals with more volume than ever, with the Affordable Care Act-authorized expansion of Medicaid adding more than 158,000 new people to the program’s rolls. Nearly 1 million Coloradans are enrolled in Medicaid.

Planning for the new system began in 2011, according to Williams, and requests for proposal were issued to find a company to build the system. HP Enterprise Services was awarded the contract earlier this week. HP Enterprise Services is the business services arm of Hewlett-Packard Co. Part of HP’s job will be to interact with providers to help them adapt to changes in submitting claims to Medicaid.

Between 75 percent and 90 percent of the cost will be paid by the federal government, with the state being responsible for the remaining expense.

The project will launch in October, with the system going live about two years later. About one year after that, in late 2017, the new system will have to obtain a system certification from Centers for Medicare and Medicaid Services.

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